Implications of emergency operations on the colon |
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| Authors: | C E Scott-Conner K S Scher |
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| Affiliation: | 1. Division of Colorectal Surgery, Department of Surgery, Brigham and Women''s Hospital, Harvard Medical School, Boston, Massachusetts;2. Center for Surgery and Public Health, Department of Surgery, Brigham and Women''s Hospital, Harvard Medical School, Boston, Massachusetts;3. Department of Surgery, St. Elizabeth''s Medical Center, Boston, Massachusetts;4. College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates;1. Department of General Surgery, The University of Texas Health Science Center, Houston, TX;2. Center for Surgical Trials and Evidence-based Practice, The University of Texas Health Science Center, Houston, TX;3. Integrative Medicine Program, Department of General Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX;1. Shanghai Institute of Geological Survey, Shanghai, 200072, PR China;2. China Institute for Urban Governance, School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, PR China;1. Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, USA;2. Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA;1. School of Health Sciences, University of Nottingham, Nottingham, UK;2. Faculty of Health and Life Sciences, De Montfort University, Leicester, UK;3. Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK;4. Richard Wells Research Centre, University of West London, London, UK;5. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI |
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| Abstract: | The records of 137 patients undergoing elective colonic operations and 45 patients requiring emergency large bowel operations were reviewed. The mortality rate was 37.8 percent after emergency operations compared with 5.1 percent after elective operations (p less than 0.001). Patient age was not a significant prognostic variable although physiologic status of the patient had a high correlation with both morbidity and mortality. Complications followed 86.7 percent of the emergency operations and 57.7 percent of the elective operations (p less than 0.001). Respiratory failure, renal and hepatic dysfunction, and cardiac events more frequently followed emergency colonic operations. Intraabdominal complications developed after 57.8 percent of the emergency operations compared with 29.9 percent of the elective operations (p less than 0.005). Colonic resection and primary anastomosis in the elective setting was associated with a 7.9 percent mortality rate. A large bowel anastomosis during an emergency operation resulted in a 70 percent mortality rate (p less than 0.001). When emergency colonic operation included creation of a colostomy the mortality rate was 34.4 percent. Although this mortality rate was substantial, it was significantly better than the 70 percent rate that followed attempted anastomosis under unfavorable circumstances (p less than 0.02). |
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